Sandra Atlas Bass Center for Liver Diseases Department of Medicine Northwell Health, 400 Community Drive, Manhasset, NY 11030, USA.
Department of Pathology, The Department of Veteran Affairs New York Harbor Healthcare System, 800 Poly Place, Brooklyn, NY 11209, USA.
Clin Liver Dis. 2019 Feb;23(1):11-23. doi: 10.1016/j.cld.2018.09.001.
Excessive alcohol consumption can lead to a spectrum of liver histopathology, including steatosis, steatohepatitis, foamy degeneration, fatty liver with cholestasis, and cirrhosis. Although variability in sampling and pathologist interpretation are of some concern, liver biopsy remains the gold standard for distinguishing between steatohepatitis and noninflammatory histologic patterns of injury that can also cause the clinical syndrome of alcohol-related hepatitis. Liver biopsy is not routinely recommended to ascertain a diagnosis of alcohol-related liver disease in patients with an uncertain alcohol history, because the histologic features of alcohol-related liver diseases can be found in other diseases, including nonalcoholic steatohepatitis and drug-induced liver injury.
过量饮酒可导致一系列肝脏组织病理学改变，包括脂肪变性、脂肪性肝炎、泡沫变性、脂肪性胆汁淤积性肝病和肝硬化。尽管取样和病理医生解读的变异性存在一些问题，但肝活检仍然是区分脂肪性肝炎和非炎症性组织学损伤模式的金标准，后者也可引起酒精性肝炎的临床综合征。对于酒精史不确定的患者，不推荐常规进行肝活检以确定酒精性肝病的诊断，因为其他疾病（包括非酒精性脂肪性肝炎和药物性肝损伤）也可有酒精性肝病的组织学特征。
